anxiety in some patients. For some surgical procedures, local
anesthesia is
impractical because of the number of injections and the amount of
anesthetic medication that would be required (e.g., breast
reconstruction)
and might result in doses that would be toxic to the patient.
The skin is prepared as for any surgical procedure, and a smallgauge
needle is used to inject a modest amount of the anesthetic
medication into
the skin layers. This produces blanching or a wheal. Additional
anesthetic
medication is then injected into the skin until an area the length of
the
proposed incision is anesthetized. A larger, longer needle then is
used to
infiltrate deeper tissues with the anesthetic agent. The action of
the agent is
almost immediate, so surgery may begin shortly after the injection
is
complete. The anesthetic may be mixed with a fast-acting
analgesic of
short duration to circumvent the burning felt when the longeracting
anesthetics are injected.
Potential Intraoperative Complications
The surgical patient is subject to several risks. Potential
intraoperative
complications include anesthesia awareness, nausea and vomiting,
anaphylaxis, hypoxia, hypothermia, and malignant hyperthermia.
The
Surgical Care Improvement Project (SCIP) set a national goal to
reduce
surgical complications. Targeted areas include surgical site
infections as
well as cardiac, respiratory, and venous thromboembolic
complications
(Joint Commission, 2016).